Implementation of diaper insecurity screening

OBJECTIVE: To describe the integration of routine diaper insecurity screening and diaper resource program within a safety net health system and to report diaper insecurity prevalence, demographic characteristics, co-existing social drivers of health (SDOH), and associated health outcomes. 

METHODS: A retrospective cross-sectional study was conducted in 9 urban Federally Qualified Health Centers (FQHC). Pediatric patients, aged 0 to 36 months, were screened for diaper insecurity from June 2022 to July 2024. Data from 16 677 unique patients were extracted and analyzed from the electronic health record. 

RESULTS: Of 16 677 pediatric patients potentially eligible for screening, 7700 (46%) were screened for diaper insecurity. Diaper insecurity prevalence was 41% (n = 3147). The highest diaper insecurity prevalence was reported by non-Hispanic Black 45% (n = 1462) and Hispanic 39.9% (n = 1352) patients, and those preferring to communicate in Haitian Creole (n = 748, 66%). Screening rates were equitable by race/ethnicity but inequitable for most preferred languages other than English.Diaper insecurity often co-occurs with other SDOH with 78% (n = 951) also reporting food insecurity; 65% (n = 963) transportation insecurity; 72% (n = 97) unhoused/homeless; 71% (n = 484) rent/mortgage payment insecurity; and 88% (n = 445) with financial insecurity; 48% (n = 1042) of households report receiving Supplemental Nutrition Assistance Program benefits.Maternal depression, low birth weight, fewer toilet training difficulties, and increased emergency department visits were all associated with diaper insecurity. 

CONCLUSION: Integration of diaper insecurity screening within a health system reveals frequent reports of diaper insecurity with significant differences in prevalence among racial, ethnic, and language subgroups. Conducting this screening in the context of a health care visit provides opportunities to connect patients to essential resources.